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General NPI Number Information
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NPI Number | 1881907517
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Entity Type | Individual
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Provider Name | KYLE DAVID BURGERS O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 939 W NORTH AVE STE 220
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City | CHICAGO
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State | IL
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Zip | 60642-8684
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Country | US
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Telephone | 312-664-3937
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Fax | 312-664-6383
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Provider Business Mailing Address
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Address Line | 310 N DESPLAINES ST UNIT A
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City | CHICAGO
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State | IL
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Zip | 60661-2003
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Country | US
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Telephone | 616-304-5106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010352
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License Number State | IL
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